Comparison Between Periarticular Analgesia Versus Intraarticular Injection for Effectiveness and Safety After Total Knee Arthroplasty.

PURPOSE: In most studies, local infiltration analgesia (LIA) can provide better analgesic effect in the early postoperative period, but the optimal technique is unknown. Our study was designed to evaluated the early clinical efficacy and safety of periarticular analgesia versus intraarticular injection in Total knee arthroplasty (TKA). DESIGN: A prospective study was conducted on 100 patients admitted for TKA. Subjects were divided into two groups: 50 in group A, 50 in Group B. METHODS: Patients in group A received periarticular analgesia with ropivacaine 300 mg and morphine 5 mg (the drugs were diluted with saline to 50 ml) in the periosteal borders, posterior capsule and extensor apparatus and subcutaneous tissues during surgery. After stitching of joint capsule, tranexamic acid (TXA) 2 g (20 ml) was injected into the articular cavity. Group B patients had all of the 70 mL mixture (ropivacaine 300 mg, morphine 5 mg and TXA 2 g) injected intraarticularly after stitching of the joint capsule. We assessed postoperative length of stay (LOS), knee functional outcome, pain, and complications after surgery. FINDINGS: There was no statistical difference in visual analog scale (VAS) scores for knee pain between the two groups on postoperative day (POD)1, 3, or 30 (P > .05). Mean postoperative LOS was 7.40 ± 1.98 days in Group A, compared to 8.02 ± 2.09 days in Group B (P > .05). No significant differences between groups were seen in the mean swelling ratio (P > .05), and no significant differences were found in the Hospital for Special Surgery (HSS) knee score and range of motion (ROM) at 30 days follow-up (P > .05). There was also no statistical difference in the incidence of complications (such as superficial wound infection, deep vein thrombosis (DVT) and nausea and vomiting) between the Group A and the Group B. CONCLUSIONS: In conclusion, it seems that intraarticular injection had a similar analgesic effect compared with periarticular injection when adopting a multi-modal analgesia regimen. Our results suggest that there is no obvious advantage with the use of periarticular injections compared to intraarticular injection. The authors believe that intraarticular injection may be a better technique compared with periarticular injections in the absence of a drainage tube because intraarticular injection can reduce the number of surgical steps and have similar postoperative outcomes.

TBX3 regulates the transcription of VEGFA to promote osteoblasts proliferation and microvascular regeneration.

Objective: Osteochondral decellularization can promote local vascular regeneration, but the exact mechanism is unknown. The aim of this study is to study osteogenic microvascular regeneration in single cells. Methods: The scRNA-seq dataset of human periosteal-derived cells (hPDCs) were analyzed by pySCENIC. To examine the role of TBX3 in osteogenesis and vascularization, cell transfection, qRT-PCR, western blot, and CCK-8 cell proliferation assays were performed. Results: TCF7L2, TBX3, FLI1, NFKB2, and EZH2 were found to be transcription factors (TFs) most closely associated with corresponding cells. The regulatory network of these TFs was then visualized. Our study knocked down the expression of TBX3 in human osteoblast cell lines. In the TBX3 knockdown group, we observed decreased expression of VEGFA, VEGFB, and VEGFC. Moreover, Western blot analysis showed that downregulating TBX3 resulted in a reduction of VEGFA expression. And TBX3 stimulated osteoblast proliferation in CCK-8 assays. Conclusion: TBX3 regulates VEGFA expression and promotes osteoblast proliferation in skeletal microvasculature formation. The findings provide a theoretical basis for investigating the role of TBX3 in promoting local vascular regeneration.

LIMS2 is Downregulated in Osteosarcoma and Inhibits Cell Growth and Migration.

Methods: GEO, GEPIA, and UALCAN databases were used to assess LIMS2 expression in OS. UALCAN and CCLE databases were applied to assess the methylation levels of LIMS2 in OS tissues and cells, which was verified in OS cells using the methylation specific PCR. The effects of LIMS2 on regulating OS cell growth, migration and invasion were determined by CCK-8, Edu staining, and transwell chambers, respectively. The role of LIMS2 in the activation of MAPK signaling was assessed using western blotting assay in OS cells. Results: LIMS2 expression was declined in OS tissues and cells, while its methylation level was increased. The low expression of LIMS2 was associated with shorter overall survival and disease-free survival. Overexpression of LIMS2 inhibited cell growth, migration, and invasion and decreased the levels of p-ERK/ERK, p-P38/P38, and p-JNK/JNK. Conclusion: LIMS2 expression was decreased in OS, which was associated with hypermethylation level and poor prognosis. LIMS2 overexpression inhibited OS cell growth and migration, which may be caused by the suppression of MAPK signaling.

Analysis of risk factors associated with flexor pollicis longus injury after volar plating of distal radius fractures.

OBJECTIVE: This study was performed to analyze the risk factors associated with flexor pollicis longus (FPL) attrition or rupture after volar plating of distal radius fractures. METHODS: Three hundred thirty-eight patients with distal radius fractures were included in this retrospective study. Univariate analysis and multivariate logistic regression analysis were performed to predict risk factors. RESULTS: Univariate analysis showed that sex, volar tilt, the Soong grade, the plate-to-critical line distance (PCLD), the plate-to-volar rim distance (PVRD), and the time of plate removal were significantly associated with FPL attrition or rupture. Multivariate logistic regression analysis demonstrated that decreased volar tilt, Soong grade 2, PCLD of >2 mm, PVRD of <3 mm, and plate removal at ≥1 year were the risk factors significantly associated with FPL attrition or rupture. CONCLUSIONS: Reduced volar tilt, Soong grade 2, PCLD of >2 mm, and PVRD of <3 mm appear to be risk factors that are significantly associated with FPL attrition or rupture. The findings of this study also suggest that the risk of tendon rupture is lower if a Soong grade 2 plate is removed, the PCLD is >2 mm, the PVRD is <3 mm, or reduced volar tilt is achieved earlier (at <1 year).

Estimation of appendicular skeletal muscle: Development and validation of anthropometric prediction equations in Chinese patients with knee osteoarthritis.

OBJECTIVE: To develop anthropometric prediction equations for estimating appendicular skeletal muscle (ASM) in Chinese knee osteoarthritis patients. METHODS: Subjects were divided into the model development group (MD group: 104 cases, 47 men and 57 women) and cross-validation group (CV group: 69 cases, 38 men and 31 women). Stepwise multiple linear regression analyses were undertaken in the MD group to identify the best equations. Agreement between the estimated ASM and ASM measured by dual-energy X-ray absorptiometry (DXA) was tested in the CV group. RESULTS: Two models were developed in the MD group. Validation in the CV group showed that our models (R2  = 0.83 and R2  = 0.90) had a high coefficient of determination. The mean bias of ASM estimated by the two models from the ASM measured by DXA in the CV group showed no significant difference (P > 0.05). CONCLUSION: These models could be useful for older Chinese patients with knee osteoarthritis to estimate ASM.

Ipsilateral femoral neck and intertrochanteric fractures with posterior dislocation of the hip: A report of two cases.

Traumatic hip dislocation usually occurs in young patients, with the increasing number of high-energy injuries, and 62-93% of reported adult traumatic hip dislocations were caused by high-speed motor vehicle crashes. However, ipsilateral femoral neck fractures and intertrochanteric fractures with posterior dislocation of the hip are extremely rare, and this injury poses a challenge to orthopaedic surgeons. Here, we report two cases of simultaneous ipsilateral femoral neck fracture, intertrochanteric fracture and posterior dislocation of the hip joint in young patients who were treated with proximal femoral locking compression plate (PFLCP). The long-term follow-up (one patient was followed up for 3 years and the other for 7 years) showed that these patients had excellent functional outcomes with near-normal ranges of hip movement. The authors believe that using smaller plates with the lateral PFLCP is an acceptable method to treat this injury in young patients.